Forget Simplicity, Give Us Truth

For now, I’ll be looking to Europe for my vaccine recommendations.

In the United States, Covid vaccine policy continues to be out of step with the world and out of touch with the people. If the CDC wishes to regain trust, they should make honesty, not simplicity their guiding principle.

Once again, a new Covid vaccine has debuted, and once again, the Center for Disease Control (CDC) has issued a recommendation that baffles me. The CDC asserts that all Americans older than six months should get the jab.

Nevermind that we have no clinical data on this new shot. Nevermind that the risk of Covid is markedly age-dependent. Nevermind that for a healthy teen who already had Omicron, for example, the risk of severe Covid from current strains must be miniscule. Everyone needs the shot, period.

Of course, we are not the only country developing Covid policy. So, how does the CDC’s recommendation compare with policy from our peer nations in Europe?

• Germany: Recommended for people 60+ and those with high-risk conditions.

• England: Recommended for people 65+ and those with high-risk conditions.

• France: Recommended for people 65+ and those with high-risk conditions.

• Denmark: Recommended for people 65+ and those with high-risk conditions.

Clearly, on the question of Covid booster policy, the United States continues to be an outlier.

What is the rationale for the CDC’s one-size-fits-all recommendation? Why is our policy so much more aggressive than that of Europe? Why advocate for a booster even to those who are very unlikely to benefit?

One rationale that has been proffered for the CDC’s blanket recommendation is that we need a simple message. For example, The Atlantic quotes Dr. Anthony Fauci as saying “‘I would recommend it for everyone’ for the sheer sake of clarity.”

Apparently, many high-risk Americans previously passed on Covid boosters, because they were confused. I guess we have a ton of 72 year-olds who are unsure if their age is greater than 65 (correct answer: it is).

For argument’s sake, let’s take this at face value, and assume that the desire for a simple message is the reason for the CDC’s aggressive Covid vaccine recommendation. By prioritizing simplicity over clinical utility, the CDC has fashioned a recommendation that will be ignored by most, and the organization will continue to lose credibility.

My predictions: The great majority of Americans will ignore the CDC and forgo the booster. Not only will their blanket recommendation not move the needle on vaccine uptake, it will paradoxically discourage vaccination, because people will consider the recommendation overzealous and reflexively dismiss the shot. More problematic, the majority of US physicians will ignore the CDC, and recommend the booster only to high-risk patients. If I am right, this is a huge problem: Do we really want doctors ignoring the advice of the CDC?

If the CDC wishes to regain credibility and trust, they should prioritize honesty over simplicity. A first step would be to provide a frank (and simple) recounting of the history of Covid vaccines — a remarkable medical achievement whose image was unfortunately tarnished by media hype and misplaced hope.

This is just fantasy, but following is the message that I would love to hear from the CDC:

In early 2020, the world was hit by a terrible and frightening pandemic. Fortunately, the pharmaceutical industry sprang into action. We hoped that they could rapidly produce a vaccine that would stop people from dying of Covid.

Incredibly, they exceeded our expectations, quickly developing vaccines that performed exceptionally well in clinical trials. In fact, the trials were so successful, that a new hope was born: the vaccines would stop people from acquiring Covid, stop people from spreading Covid, and stop the virus in its tracks.

Led by this new hope, we encouraged all Americans to get vaccinated. Vaccination was no longer a question of personal risk reduction, but a civic obligation to end the pandemic. Unfortunately, this second, bigger hope was dashed — the viral waves continued to crash, and we all got sick, regardless of our vaccination status.

Thankfully, the original promise held true: the vaccine continued to offer protection from severe disease. But clearly, we have needed to lower our expectations of what these vaccines can do.

As we have scaled back our expectations, so too have we scaled back our recommendations — we now recommend a Covid vaccine booster to people aged 65 and older, and for those younger patients who have medical conditions that place them at increased risk for complicated Covid infection. If you are uncertain whether you are at high risk, please consult a physician.

If you are not high-risk, but would nevertheless prefer to have a booster, please do so. There continues to be significant uncertainty around Covid and Covid vaccines, and in areas of medical uncertainty, personal preference should guide decision making.

No, I am not holding my breath that Dr. Fauci will emerge from retirement to deliver the above speech. So for now, I’ll be looking to Europe for my vaccine recommendations.